Abdominal pain after anterior resection

Chief Complaint A 68-year-old male presents with Increased abdominal pain. History He had an anterior resection 1 week ago. Now he presented with increased abdominal pain. Vitals BP is 95/70 mmHg. Temperature: 101.2 degree F. Pulse: 115 bpm. Abdomen is tender along with rigidity. Diagnosis What is the cause of his abdominal pain?



Post operative peritonitis. Most likely an anastomotic leak from the colo- anal anastomosis leading to faecal peritonitis.. An urgent MRI with contrast is indicated to pin - point the anastomotic leak . Mean - while start with NPO, RT suction, IV fluids, Parenteral antibiotics 3rd generation cephalosporins. Depending upon the MRI report further treatment is required Options are . An intra - Abdominal drain to be kept if leakage is very small and continue conservative treatment maintaining hydration and electrolyte disturbances. 2.Exploratory laparotomy 3.A colostomy

As per history pt had ant resection 7 days ago having pain abdomen and rise of temperature with tachycardia suggestive of infection. Infection may be from site infection or due to.leakage form the anastomosis site more common with low anterior resection causing more post operative mortality. If there is leakage from site leading to pertonitis with collection in pelvis causing pain abdomen with rise of temperature. CT abdomen to see the site and amount of collection which may need drainage under CT guidance by a.pigtail cather Culture and sensitivity of the for proper antibiotic IV drip to mainain nutrition Antibiotic as per culture report Multivitamin infusion Blood for total examintion and see kidney function, electrolytes If the condition improves to continue treatment and if found repeated collection then colostomy may be required to minimise the leakage.

Post operative peritonitis Conservative treatment. Nothing by .mouth. Needs further investigation and evaluation to conclude till reports complied BS antibiotics iv bd slowly. Iv infusion for electrolytes . Multivitamin through drip. Regular monitoring and constant evaluation required.

Thanks Dr Parveen Yograj

In a case of anterior resection, there is coloanal anastomosis There is always a chance of leak of Intestinal content out of lumen from coloanal anastomosis This is most common and important cause of postoperative complications after anterior resection Adv CT scan of abdomen and pelvis with contrast to assess the leak and to find any collection in pelvis - of required insertion of CT guided Pigtail insertion to drain any collection Appropriate higher Antibiotics Keep nil by mouth Parenteral nutrition to improve nutritional status - will insulin infusion to control blood sugar Blood culture, complete blood count, Procalcitonin, renal function test, electrolyte analysis Important some times emergency surgery to take down anastomosis and to do colostomy may be required

Acute Peritonitis

I think Post Operative sepsis Get CBC CRP, CT abdomen and pelvis Broad spectrum antibiotics Anti-inflammatory

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